{"id":13224,"date":"2021-06-17T16:45:42","date_gmt":"2021-06-17T16:45:42","guid":{"rendered":"https:\/\/milehighchiro.org\/add-directory-listing\/"},"modified":"2022-01-11T22:11:08","modified_gmt":"2022-01-11T22:11:08","slug":"add-directory-listing","status":"publish","type":"page","link":"https:\/\/milehighchiro.org\/add-directory-listing\/","title":{"rendered":"Add Listing"},"content":{"rendered":"<p style=\"display:none\">Make it easy for other Chiropractors to find you when they need to refer practice members, friends, or family to a doctor in your area! You never know what kind of awesome referral you\u2019ll receive.<\/p>\n<p>You&#8217;re halfway there! Fill these out too. Don&#8217;t leave any as blank since these are the information that people will see when they search your practice on the Mile High Directory.  Once you&#8217;re done, click SUBMIT<\/p>\n<div style=\"color:#000; padding: 10px; background-color:rgb(255, 248, 181); margin-bottom: 20px; text-align:center;\">Tip: Upload your best image! People would love to see YOU! (Images can be your Logo, your clinic, yourself, or a combination of all!)<\/div>\n<div id=\"drts-platform-render-6634adbdd5b07-1\" class=\"drts drts-main\"><h2>Directory: Add Listing<\/h2>\n\n<form id=\"drts-form-61981f2df1c38cf396c602f328ddf52f\" method=\"post\" action=\"https:\/\/milehighchiro.org\/add-directory-listing\/\" class=\"drts-form drts-frontendsubmit-addentity-add drts-entity-form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-form-name=\"frontendsubmit_addentity_add\">\n<div data-display-type=\"form\" data-display-name=\"default\" class=\"drts-display drts-display-name-form-default drts-display-default-default\"><div data-name=\"entity_form_entity_title\" class=\"drts-display-element drts-display-element-entity_form_entity_title-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-entity-title drts-entity-form-field-name-post-title drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[post_title]\">\n<label>Office Name<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-form-field drts-form-type-textfield drts-form-required\" style=\"\" data-form-field-name=\"drts[post_title][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[post_title][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_string\" class=\"drts-display-element drts-display-element-entity_form_string-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-string drts-entity-form-field-name-field-name-doctor-name drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[field_name_doctor_name]\">\n<label>Name (Doctor Name)<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-form-field drts-form-type-textfield drts-form-required\" style=\"\" data-form-field-name=\"drts[field_name_doctor_name][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_name_doctor_name][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_phone\" class=\"drts-display-element drts-display-element-entity_form_phone-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-phone drts-entity-form-field-name-field-phone drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[field_phone]\">\n<label>Phone Number<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-form-field drts-form-type-textfield drts-form-required\" style=\"\" data-form-field-name=\"drts[field_phone][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_phone][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_email\" class=\"drts-display-element drts-display-element-entity_form_email-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-email drts-entity-form-field-name-field-email drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[field_email]\">\n<label>E-mail Address<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-form-field drts-form-type-email drts-form-required\" style=\"\" data-form-field-name=\"drts[field_email][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_email][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_url\" class=\"drts-display-element drts-display-element-entity_form_url-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-url drts-entity-form-field-name-field-website drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_website]\">\n<label>Website URL<\/label>\n<div class=\"drts-form-field drts-form-type-url\" style=\"\" data-form-field-name=\"drts[field_website][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_website][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_social_accounts\" class=\"drts-display-element drts-display-element-entity_form_social_accounts-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-social-accounts drts-entity-form-field-name-field-social-accounts drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_social_accounts]\">\n<label>Social Accounts<\/label>\n<div class=\"drts-bs-form-text drts-form-description drts-bs-mb-3 drts-bs-mt-0\">Please enter your social media URLs<\/div>\n<div class=\"drts-row drts-form-row drts-gutter-md\">\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][facebook]\" data-social-media-name=\"facebook\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-facebook-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][facebook]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter Facebook username or URL.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][instagram]\" data-social-media-name=\"instagram\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-instagram-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][instagram]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter Instagram username or URL. Prefix with &quot;#&quot; if hashtag.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_string\" class=\"drts-display-element drts-display-element-entity_form_string-2 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-string drts-entity-form-field-name-field-school-graduated drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_school_graduated]\">\n<label>School Graduated<\/label>\n<div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_school_graduated][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_school_graduated][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_wp_image\" class=\"drts-display-element drts-display-element-entity_form_wp_image-1 \" style=\"\"><div class=\"drts-bs-form-group drts-form-upload-container drts-entity-form-field drts-entity-form-field-type-wp-image drts-entity-form-field-name-directory-photos drts-form-field drts-form-type-wp-upload drts-form-required\" style=\"\" data-form-field-name=\"drts[directory_photos]\">\n<label>Photos<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-bs-form-text drts-form-description drts-bs-mb-3 drts-bs-mt-0\">Upload your best image! People would love to see YOU!<\/div>\n<div class=\"drts-form-upload-current drts-data-table drts-form-field drts-form-type-grid drts-form-required\" style=\"\" data-form-field-name=\"drts[directory_photos][current]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-table-responsive-md\"><table class=\"drts-bs-table drts-bs-my-0 drts-bs-table-sm\" style=\"margin-bottom:0;\">\n<thead><tr>\n<th data-column-name=\"icon\" style=\"width:20%;text-align:center;\"><\/th>\n<th data-column-name=\"name\" style=\"width:50%;\">File Name<\/th>\n<th data-column-name=\"size\" style=\"width:15%;\">File Size<\/th>\n<th data-column-name=\"check\" style=\"text-align:center;\"><\/th>\n<\/tr><\/thead>\n<tbody>\n<tr><td colspan=\"4\">No entries found<\/td><\/tr>\n<\/tbody>\n<\/table><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-form-upload drts-form-field drts-form-type-file drts-form-required\" style=\"\" data-form-field-name=\"drts[directory_photos][upload]\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-directory-photos-upload\">\n    \n    <div class=\"drts-form-field-main\">\n        <div class=\"drts-bs-form-text drts-form-description drts-bs-mt-0 drts-bs-mb-3\">Max file size 2MB. Supported file formats: gif jpeg jpg png<\/div>\n        <span class=\"drts-bs-btn drts-bs-btn-sm drts-bs-btn-outline-secondary drts-form-file-button\">\n    <i class=\"fas fa-folder-open\"><\/i> <span>Choose File<\/span>\n    <input type=\"file\" name=\"drts[directory_photos][upload][files][]\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-directory-photos-file\" multiple=\"multiple\" \/>\n<\/span>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-bs-progress drts-bs-mt-1\" style=\"display:none;\"><div class=\"drts-bs-progress-bar\" role=\"progressbar\" aria-valuenow=\"0\" aria-valuemin=\"0\" aria-valuemax=\"100\"><\/div><\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_text\" class=\"drts-display-element drts-display-element-entity_form_text-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-text drts-entity-form-field-name-field-bio drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_bio]\">\n<label>About<\/label>\n<div class=\"drts-form-field drts-form-type-textarea\" style=\"\" data-form-field-name=\"drts[field_bio][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <textarea name=\"drts[field_bio][0]\" class=\"drts-bs-form-control\" rows=\"10\"><\/textarea>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_choice\" class=\"drts-display-element drts-display-element-entity_form_choice-2 describes\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-choice drts-entity-form-field-name-field-your-practice-select-all-that-apply drts-form-field drts-form-type-checkboxes drts-form-required\" style=\"\" data-form-field-name=\"drts[field_your_practice_select_all_that_apply]\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply\">\n    <label>Which of these best describes your practice select all that apply:<span class=\"drts-form-field-required\">*<\/span><\/label>\n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-form-row\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-options\">\n<div class=\"drts-bs-col-sm-12\"><div class=\"drts-form-field-radio-options drts-form-field-radio-options-column drts-bs-custom-controls-stacked\">\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Subluxation\/Adjustment Focused\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Subluxation\/Adjustment Focused\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Subluxation\/Adjustment Focused\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Subluxation\/Adjustment Focused\">Subluxation\/Adjustment Focused<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Subluxation-based and includes nutrition, exercise, massage, lifestyle advice, etc.\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Subluxation-based and includes nutrition, exercise, massage, lifestyle advice, etc.\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Subluxation-based and includes nutrition, exercise, massage, lifestyle advice, etc.\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Subluxation-based and includes nutrition, exercise, massage, lifestyle advice, etc.\">Subluxation-based and includes nutrition, exercise, massage, lifestyle advice, etc.<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Wholistic health center primarily nutrition-focused\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Wholistic health center primarily nutrition-focused\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Wholistic health center primarily nutrition-focused\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Wholistic health center primarily nutrition-focused\">Wholistic health center primarily nutrition-focused<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Natural pain relief center\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Natural pain relief center\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Natural pain relief center\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Natural pain relief center\">Natural pain relief center<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Multi-disciplinary center MD\/DC\/PT or similar\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Multi-disciplinary center MD\/DC\/PT or similar\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Multi-disciplinary center MD\/DC\/PT or similar\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Multi-disciplinary center MD\/DC\/PT or similar\">Multi-disciplinary center MD\/DC\/PT or similar<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Functional rehabilitation center including chiropractic, therapeutic exercise, physical therapy, etc.\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Functional rehabilitation center including chiropractic, therapeutic exercise, physical therapy, etc.\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Functional rehabilitation center including chiropractic, therapeutic exercise, physical therapy, etc.\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Functional rehabilitation center including chiropractic, therapeutic exercise, physical therapy, etc.\">Functional rehabilitation center including chiropractic, therapeutic exercise, physical therapy, etc.<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Other-please describe\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Other-please describe\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Other-please describe\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Other-please describe\">Other-please describe<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Chiropractic Analysis \/ Technique Provided : (Fill IN )\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Chiropractic Analysis \/ Technique Provided : (Fill IN )\" name=\"drts[field_your_practice_select_all_that_apply][]\" value=\"Chiropractic Analysis \/ Technique Provided : (Fill IN )\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-your-practice-select-all-that-apply-Chiropractic Analysis \/ Technique Provided : (Fill IN )\">Chiropractic Analysis \/ Technique Provided : (Fill IN )<\/label><\/div>\n<\/div><\/div>\n<\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_string\" class=\"drts-display-element drts-display-element-entity_form_string-3 \" style=\"\"><div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_technique_provided][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_technique_provided][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_choice\" class=\"drts-display-element drts-display-element-entity_form_choice-1 professional_organizations\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-choice drts-entity-form-field-name-field-professional-organizations-memberships-selec drts-form-field drts-form-type-checkboxes drts-form-required\" style=\"\" data-form-field-name=\"drts[field_professional_organizations_memberships_selec]\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec\">\n    <label>Professional organizations memberships: Select all that apply<span class=\"drts-form-field-required\">*<\/span><\/label>\n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-form-row\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-options\">\n<div class=\"drts-bs-col-sm-12\"><div class=\"drts-form-field-radio-options drts-form-field-radio-options-column drts-bs-custom-controls-stacked\">\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"IFCO\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-IFCO\" name=\"drts[field_professional_organizations_memberships_selec][]\" value=\"IFCO\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-IFCO\">IFCO<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"ICA\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-ICA\" name=\"drts[field_professional_organizations_memberships_selec][]\" value=\"ICA\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-ICA\">ICA<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"ACA\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-ACA\" name=\"drts[field_professional_organizations_memberships_selec][]\" value=\"ACA\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-ACA\">ACA<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"CCA\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-CCA\" name=\"drts[field_professional_organizations_memberships_selec][]\" value=\"CCA\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-CCA\">CCA<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"ICPA\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-ICPA\" name=\"drts[field_professional_organizations_memberships_selec][]\" value=\"ICPA\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-ICPA\">ICPA<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"None\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-None\" name=\"drts[field_professional_organizations_memberships_selec][]\" value=\"None\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-None\">None<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Other\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-Other\" name=\"drts[field_professional_organizations_memberships_selec][]\" value=\"Other\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-professional-organizations-memberships-selec-Other\">Other<\/label><\/div>\n<\/div><\/div>\n<\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_string\" class=\"drts-display-element drts-display-element-entity_form_string-4 \" style=\"\"><div class=\"drts-form-wrap\" style=\"\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-other\">\n<div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_other][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_other][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_choice\" class=\"drts-display-element drts-display-element-entity_form_choice-3 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-choice drts-entity-form-field-name-field-are-you-a-member-of-the-lifetime-wellness-pr drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[field_are_you_a_member_of_the_lifetime_wellness_pr]\">\n<label>Are you a Member of The Lifetime Wellness Practice Inner Circle?<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-form-field drts-form-type-radios drts-form-required\" style=\"\" data-form-field-name=\"drts[field_are_you_a_member_of_the_lifetime_wellness_pr][0]\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-lifetime-wellness-pr-0\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-form-row\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-lifetime-wellness-pr-0-options\">\n<div class=\"drts-bs-col-sm-12\"><div class=\"drts-form-field-radio-options drts-form-field-radio-options-column drts-bs-custom-controls-stacked\">\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-radio drts-bs-my-1\" data-depth=\"0\" data-value=\"Yes\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"radio\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-lifetime-wellness-pr-0-Yes\" name=\"drts[field_are_you_a_member_of_the_lifetime_wellness_pr][0]\" value=\"Yes\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-lifetime-wellness-pr-0-Yes\">Yes<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-radio drts-bs-my-1\" data-depth=\"0\" data-value=\"No\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"radio\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-lifetime-wellness-pr-0-No\" name=\"drts[field_are_you_a_member_of_the_lifetime_wellness_pr][0]\" value=\"No\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-lifetime-wellness-pr-0-No\">No<\/label><\/div>\n<\/div><\/div>\n<\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_choice\" class=\"drts-display-element drts-display-element-entity_form_choice-4 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-choice drts-entity-form-field-name-field-are-you-a-member-of-the-network-group drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[field_are_you_a_member_of_the_network_group]\">\n<label>Are you a Member of the Network Group?<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-form-field drts-form-type-radios drts-form-required\" style=\"\" data-form-field-name=\"drts[field_are_you_a_member_of_the_network_group][0]\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-network-group-0\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-form-row\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-network-group-0-options\">\n<div class=\"drts-bs-col-sm-12\"><div class=\"drts-form-field-radio-options drts-form-field-radio-options-column drts-bs-custom-controls-stacked\">\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-radio drts-bs-my-1\" data-depth=\"0\" data-value=\"Yes\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"radio\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-network-group-0-Yes\" name=\"drts[field_are_you_a_member_of_the_network_group][0]\" value=\"Yes\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-network-group-0-Yes\">Yes<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-radio drts-bs-my-1\" data-depth=\"0\" data-value=\"No\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"radio\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-network-group-0-No\" name=\"drts[field_are_you_a_member_of_the_network_group][0]\" value=\"No\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-are-you-a-member-of-the-network-group-0-No\">No<\/label><\/div>\n<\/div><\/div>\n<\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_location_address\" class=\"drts-display-element drts-display-element-entity_form_location_address-3 subformmap-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-location-address drts-entity-form-field-name-field-location-new drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[field_location_new]\">\n<label>Location<span class=\"drts-form-field-required\">*<\/span><\/label>\n<div class=\"drts-bs-form-group drts-location-address-container drts-form-field drts-form-type-fieldset drts-form-required\" style=\"\" data-form-field-name=\"drts[field_location_new][0]\">\n<div class=\"drts-bs-form-group drts-form-field drts-form-type-location-address\" style=\"\" data-scrollwheel=\"0\" data-center-lng=\"0\" data-center-lat=\"0\" data-lng=\"\" data-lat=\"\" data-zoom=\"5\" data-map-type=\"roadmap\" data-form-field-name=\"drts[field_location_new][0][location][address]\">\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield drts-form-required\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][street]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>Address Line 1<span class=\"drts-form-field-required\">*<\/span><\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[field_location_new][0][location][address][street]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-street\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield drts-form-required\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][zip]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>Postal \/ Zip Code<span class=\"drts-form-field-required\">*<\/span><\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[field_location_new][0][location][address][zip]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-zip\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield drts-form-required\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][city]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>City<span class=\"drts-form-field-required\">*<\/span><\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[field_location_new][0][location][address][city]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-city\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield drts-form-required\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][province]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>State \/ Province \/ Region<span class=\"drts-form-field-required\">*<\/span><\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[field_location_new][0][location][address][province]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-province\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-select drts-form-required\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][country]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>Country<span class=\"drts-form-field-required\">*<\/span><\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <select class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-country\" name=\"drts[field_location_new][0][location][address][country]\" ><option value=\"\">\u2014 Select \u2014<\/option>\n<option value=\"Afghanistan\">Afghanistan<\/option>\n<option value=\"Aland Islands\">Aland Islands<\/option>\n<option value=\"Albania\">Albania<\/option>\n<option value=\"Algeria\">Algeria<\/option>\n<option value=\"American Samoa\">American Samoa<\/option>\n<option value=\"Andorra\">Andorra<\/option>\n<option value=\"Angola\">Angola<\/option>\n<option value=\"Anguilla\">Anguilla<\/option>\n<option value=\"Antarctica\">Antarctica<\/option>\n<option value=\"Antigua And Barbuda\">Antigua And Barbuda<\/option>\n<option value=\"Argentina\">Argentina<\/option>\n<option value=\"Armenia\">Armenia<\/option>\n<option value=\"Aruba\">Aruba<\/option>\n<option value=\"Australia\">Australia<\/option>\n<option value=\"Austria\">Austria<\/option>\n<option value=\"Azerbaijan\">Azerbaijan<\/option>\n<option value=\"Bahamas\">Bahamas<\/option>\n<option value=\"Bahrain\">Bahrain<\/option>\n<option value=\"Bangladesh\">Bangladesh<\/option>\n<option value=\"Barbados\">Barbados<\/option>\n<option value=\"Belarus\">Belarus<\/option>\n<option value=\"Belgium\">Belgium<\/option>\n<option value=\"Belize\">Belize<\/option>\n<option value=\"Benin\">Benin<\/option>\n<option value=\"Bermuda\">Bermuda<\/option>\n<option value=\"Bhutan\">Bhutan<\/option>\n<option value=\"Bolivia\">Bolivia<\/option>\n<option value=\"Bosnia And Herzegovina\">Bosnia And Herzegovina<\/option>\n<option value=\"Botswana\">Botswana<\/option>\n<option value=\"Bouvet Island\">Bouvet Island<\/option>\n<option value=\"Brazil\">Brazil<\/option>\n<option value=\"British Indian Ocean Territory\">British Indian Ocean Territory<\/option>\n<option value=\"British Virgin Islands\">British Virgin Islands<\/option>\n<option value=\"Brunei Darussalam\">Brunei Darussalam<\/option>\n<option value=\"Bulgaria\">Bulgaria<\/option>\n<option value=\"Burkina Faso\">Burkina Faso<\/option>\n<option value=\"Burundi\">Burundi<\/option>\n<option value=\"Cambodia\">Cambodia<\/option>\n<option value=\"Cameroon\">Cameroon<\/option>\n<option value=\"Canada\">Canada<\/option>\n<option value=\"Cape Verde\">Cape Verde<\/option>\n<option value=\"Cayman Islands\">Cayman Islands<\/option>\n<option value=\"Central African Republic\">Central African Republic<\/option>\n<option value=\"Chad\">Chad<\/option>\n<option value=\"Chile\">Chile<\/option>\n<option value=\"China\">China<\/option>\n<option value=\"Christmas Island\">Christmas Island<\/option>\n<option value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands<\/option>\n<option value=\"Colombia\">Colombia<\/option>\n<option value=\"Comoros\">Comoros<\/option>\n<option value=\"Congo\">Congo<\/option>\n<option value=\"Congo, Democratic Republic\">Congo, Democratic Republic<\/option>\n<option value=\"Cook Islands\">Cook Islands<\/option>\n<option value=\"Costa Rica\">Costa Rica<\/option>\n<option value=\"Cote D&#039;Ivoire\">Cote D&#039;Ivoire<\/option>\n<option value=\"Croatia\">Croatia<\/option>\n<option value=\"Cuba\">Cuba<\/option>\n<option value=\"Cyprus\">Cyprus<\/option>\n<option value=\"Czech Republic\">Czech Republic<\/option>\n<option value=\"Denmark\">Denmark<\/option>\n<option value=\"Djibouti\">Djibouti<\/option>\n<option value=\"Dominica\">Dominica<\/option>\n<option value=\"Dominican Republic\">Dominican Republic<\/option>\n<option value=\"Ecuador\">Ecuador<\/option>\n<option value=\"Egypt\">Egypt<\/option>\n<option value=\"El Salvador\">El Salvador<\/option>\n<option value=\"Equatorial Guinea\">Equatorial Guinea<\/option>\n<option value=\"Eritrea\">Eritrea<\/option>\n<option value=\"Estonia\">Estonia<\/option>\n<option value=\"Ethiopia\">Ethiopia<\/option>\n<option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/option>\n<option value=\"Faroe Islands\">Faroe Islands<\/option>\n<option value=\"Federated States of Micronesia\">Federated States of Micronesia<\/option>\n<option value=\"Fiji\">Fiji<\/option>\n<option value=\"Finland\">Finland<\/option>\n<option value=\"France\">France<\/option>\n<option value=\"French Guiana\">French Guiana<\/option>\n<option value=\"French Polynesia\">French Polynesia<\/option>\n<option value=\"French Southern Territories\">French Southern Territories<\/option>\n<option value=\"Gabon\">Gabon<\/option>\n<option value=\"Gambia\">Gambia<\/option>\n<option value=\"Georgia\">Georgia<\/option>\n<option value=\"Germany\">Germany<\/option>\n<option value=\"Ghana\">Ghana<\/option>\n<option value=\"Gibraltar\">Gibraltar<\/option>\n<option value=\"Greece\">Greece<\/option>\n<option value=\"Greenland\">Greenland<\/option>\n<option value=\"Grenada\">Grenada<\/option>\n<option value=\"Guadeloupe\">Guadeloupe<\/option>\n<option value=\"Guam\">Guam<\/option>\n<option value=\"Guatemala\">Guatemala<\/option>\n<option value=\"Guernsey\">Guernsey<\/option>\n<option value=\"Guinea\">Guinea<\/option>\n<option value=\"Guinea-Bissau\">Guinea-Bissau<\/option>\n<option value=\"Guyana\">Guyana<\/option>\n<option value=\"Haiti\">Haiti<\/option>\n<option value=\"Heard Island &amp; Mcdonald Islands\">Heard Island &amp; Mcdonald Islands<\/option>\n<option value=\"Holy See (Vatican City State)\">Holy See (Vatican City State)<\/option>\n<option value=\"Honduras\">Honduras<\/option>\n<option value=\"Hong Kong\">Hong Kong<\/option>\n<option value=\"Hungary\">Hungary<\/option>\n<option value=\"Iceland\">Iceland<\/option>\n<option value=\"India\">India<\/option>\n<option value=\"Indonesia\">Indonesia<\/option>\n<option value=\"Iran\">Iran<\/option>\n<option value=\"Iraq\">Iraq<\/option>\n<option value=\"Ireland\">Ireland<\/option>\n<option value=\"Isle Of Man\">Isle Of Man<\/option>\n<option value=\"Israel\">Israel<\/option>\n<option value=\"Italy\">Italy<\/option>\n<option value=\"Jamaica\">Jamaica<\/option>\n<option value=\"Japan\">Japan<\/option>\n<option value=\"Jersey\">Jersey<\/option>\n<option value=\"Jordan\">Jordan<\/option>\n<option value=\"Kazakhstan\">Kazakhstan<\/option>\n<option value=\"Kenya\">Kenya<\/option>\n<option value=\"Kiribati\">Kiribati<\/option>\n<option value=\"Korea\">Korea<\/option>\n<option value=\"Kuwait\">Kuwait<\/option>\n<option value=\"Kyrgyzstan\">Kyrgyzstan<\/option>\n<option value=\"Lao People&#039;s Democratic Republic\">Lao People&#039;s Democratic Republic<\/option>\n<option value=\"Latvia\">Latvia<\/option>\n<option value=\"Lebanon\">Lebanon<\/option>\n<option value=\"Lesotho\">Lesotho<\/option>\n<option value=\"Liberia\">Liberia<\/option>\n<option value=\"Libyan Arab Jamahiriya\">Libyan Arab Jamahiriya<\/option>\n<option value=\"Liechtenstein\">Liechtenstein<\/option>\n<option value=\"Lithuania\">Lithuania<\/option>\n<option value=\"Luxembourg\">Luxembourg<\/option>\n<option value=\"Macao\">Macao<\/option>\n<option value=\"Macedonia\">Macedonia<\/option>\n<option value=\"Madagascar\">Madagascar<\/option>\n<option value=\"Malawi\">Malawi<\/option>\n<option value=\"Malaysia\">Malaysia<\/option>\n<option value=\"Maldives\">Maldives<\/option>\n<option value=\"Mali\">Mali<\/option>\n<option value=\"Malta\">Malta<\/option>\n<option value=\"Marshall Islands\">Marshall Islands<\/option>\n<option value=\"Martinique\">Martinique<\/option>\n<option value=\"Mauritania\">Mauritania<\/option>\n<option value=\"Mauritius\">Mauritius<\/option>\n<option value=\"Mayotte\">Mayotte<\/option>\n<option value=\"Mexico\">Mexico<\/option>\n<option value=\"Moldova\">Moldova<\/option>\n<option value=\"Monaco\">Monaco<\/option>\n<option value=\"Mongolia\">Mongolia<\/option>\n<option value=\"Montenegro\">Montenegro<\/option>\n<option value=\"Montserrat\">Montserrat<\/option>\n<option value=\"Morocco\">Morocco<\/option>\n<option value=\"Mozambique\">Mozambique<\/option>\n<option value=\"Myanmar\">Myanmar<\/option>\n<option value=\"Namibia\">Namibia<\/option>\n<option value=\"Nauru\">Nauru<\/option>\n<option value=\"Nepal\">Nepal<\/option>\n<option value=\"Netherlands\">Netherlands<\/option>\n<option value=\"Netherlands Antilles\">Netherlands Antilles<\/option>\n<option value=\"New Caledonia\">New Caledonia<\/option>\n<option value=\"New Zealand\">New Zealand<\/option>\n<option value=\"Nicaragua\">Nicaragua<\/option>\n<option value=\"Niger\">Niger<\/option>\n<option value=\"Nigeria\">Nigeria<\/option>\n<option value=\"Niue\">Niue<\/option>\n<option value=\"Norfolk Island\">Norfolk Island<\/option>\n<option value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option>\n<option value=\"Norway\">Norway<\/option>\n<option value=\"Oman\">Oman<\/option>\n<option value=\"Pakistan\">Pakistan<\/option>\n<option value=\"Palau\">Palau<\/option>\n<option value=\"Palestinian Territories\">Palestinian Territories<\/option>\n<option value=\"Panama\">Panama<\/option>\n<option value=\"Papua New Guinea\">Papua New Guinea<\/option>\n<option value=\"Paraguay\">Paraguay<\/option>\n<option value=\"Peru\">Peru<\/option>\n<option value=\"Philippines\">Philippines<\/option>\n<option value=\"Pitcairn\">Pitcairn<\/option>\n<option value=\"Poland\">Poland<\/option>\n<option value=\"Portugal\">Portugal<\/option>\n<option value=\"Puerto Rico\">Puerto Rico<\/option>\n<option value=\"Qatar\">Qatar<\/option>\n<option value=\"Reunion\">Reunion<\/option>\n<option value=\"Romania\">Romania<\/option>\n<option value=\"Russian Federation\">Russian Federation<\/option>\n<option value=\"Rwanda\">Rwanda<\/option>\n<option value=\"Saint Barthelemy\">Saint Barthelemy<\/option>\n<option value=\"Saint Helena\">Saint Helena<\/option>\n<option value=\"Saint Kitts And Nevis\">Saint Kitts And Nevis<\/option>\n<option value=\"Saint Lucia\">Saint Lucia<\/option>\n<option value=\"Saint Martin\">Saint Martin<\/option>\n<option value=\"Saint Pierre And Miquelon\">Saint Pierre And Miquelon<\/option>\n<option value=\"Saint Vincent And Grenadines\">Saint Vincent And Grenadines<\/option>\n<option value=\"Samoa\">Samoa<\/option>\n<option value=\"San Marino\">San Marino<\/option>\n<option value=\"Sao Tome And Principe\">Sao Tome And Principe<\/option>\n<option value=\"Saudi Arabia\">Saudi Arabia<\/option>\n<option value=\"Senegal\">Senegal<\/option>\n<option value=\"Serbia\">Serbia<\/option>\n<option value=\"Seychelles\">Seychelles<\/option>\n<option value=\"Sierra Leone\">Sierra Leone<\/option>\n<option value=\"Singapore\">Singapore<\/option>\n<option value=\"Slovakia\">Slovakia<\/option>\n<option value=\"Slovenia\">Slovenia<\/option>\n<option value=\"Solomon Islands\">Solomon Islands<\/option>\n<option value=\"Somalia\">Somalia<\/option>\n<option value=\"South Africa\">South Africa<\/option>\n<option value=\"South Georgia And Sandwich Isl.\">South Georgia And Sandwich Isl.<\/option>\n<option value=\"Spain\">Spain<\/option>\n<option value=\"Sri Lanka\">Sri Lanka<\/option>\n<option value=\"Sudan\">Sudan<\/option>\n<option value=\"Suriname\">Suriname<\/option>\n<option value=\"Svalbard And Jan Mayen\">Svalbard And Jan Mayen<\/option>\n<option value=\"Swaziland\">Swaziland<\/option>\n<option value=\"Sweden\">Sweden<\/option>\n<option value=\"Switzerland\">Switzerland<\/option>\n<option value=\"Syrian Arab Republic\">Syrian Arab Republic<\/option>\n<option value=\"Taiwan\">Taiwan<\/option>\n<option value=\"Tajikistan\">Tajikistan<\/option>\n<option value=\"Tanzania\">Tanzania<\/option>\n<option value=\"Thailand\">Thailand<\/option>\n<option value=\"Timor-Leste\">Timor-Leste<\/option>\n<option value=\"Togo\">Togo<\/option>\n<option value=\"Tokelau\">Tokelau<\/option>\n<option value=\"Tonga\">Tonga<\/option>\n<option value=\"Trinidad And Tobago\">Trinidad And Tobago<\/option>\n<option value=\"Tunisia\">Tunisia<\/option>\n<option value=\"Turkey\">Turkey<\/option>\n<option value=\"Turkmenistan\">Turkmenistan<\/option>\n<option value=\"Turks And Caicos Islands\">Turks And Caicos Islands<\/option>\n<option value=\"Tuvalu\">Tuvalu<\/option>\n<option value=\"U.S. Virgin Islands\">U.S. Virgin Islands<\/option>\n<option value=\"Uganda\">Uganda<\/option>\n<option value=\"Ukraine\">Ukraine<\/option>\n<option value=\"United Arab Emirates\">United Arab Emirates<\/option>\n<option value=\"United Kingdom\">United Kingdom<\/option>\n<option value=\"United States\">United States<\/option>\n<option value=\"United States Outlying Islands\">United States Outlying Islands<\/option>\n<option value=\"Uruguay\">Uruguay<\/option>\n<option value=\"Uzbekistan\">Uzbekistan<\/option>\n<option value=\"Vanuatu\">Vanuatu<\/option>\n<option value=\"Venezuela\">Venezuela<\/option>\n<option value=\"Viet Nam\">Viet Nam<\/option>\n<option value=\"Wallis And Futuna\">Wallis And Futuna<\/option>\n<option value=\"Western Sahara\">Western Sahara<\/option>\n<option value=\"Yemen\">Yemen<\/option>\n<option value=\"Zambia\">Zambia<\/option>\n<option value=\"Zimbabwe\">Zimbabwe<\/option><\/select>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-location-address-field-buttons drts-bs-mb-2\">\n<button type=\"button\" class=\"drts-bs-btn drts-bs-btn-outline-secondary drts-bs-btn-sm drts-location-find-address\" data-overwrite-fields=\"\"><i class=\"fas fa-search fa-fw\"><\/i> Find on map<\/button>\n<button type=\"button\" style=\"display:none;\" class=\"drts-bs-btn drts-bs-btn-outline-secondary drts-bs-btn-sm drts-location-geolocate\"><i class=\"fas fa-location-arrow fa-fw\"><\/i> Current location<\/button>\n<button type=\"button\" class=\"drts-bs-btn drts-bs-btn-outline-danger drts-bs-btn-sm drts-location-clear-address\"><i class=\"fas fa-times fa-fw\"><\/i> Clear map<\/button>\n<\/div>\n<div class=\"drts-form-field drts-form-type-item\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][map]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div style=\"height:300px;\" class=\"drts-map-map\" data-form-field-name=\"drts[field_location_new][0][location][address][map]\"><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-form-field drts-form-type-checkbox\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][manual]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-mt-1 \" data-value=\"1\">\n    <input class=\"drts-location-address-manual drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-location-new-0-location-address-manual\" name=\"drts[field_location_new][0][location][address][manual][]\" value=\"1\" >\n    <label class=\"drts-bs-custom-control-label\" for=\"drts-form-61981f2df1c38cf396c602f328ddf52f-drts-field-location-new-0-location-address-manual\">Enter geolocation info manually<\/label>\n<\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-bs-form-group drts-location-address-timezone drts-form-field drts-form-type-select\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][timezone]\">\n    <label>Timezone<\/label>\n    <div class=\"drts-form-field-main\">\n        \n        <select class=\"drts-bs-form-control \" name=\"drts[field_location_new][0][location][address][timezone]\" data-default-value=\"Europe\/London\"><option value=\"\"><\/option>\n<option value=\"Africa\/Abidjan\">Africa\/Abidjan<\/option>\n<option value=\"Africa\/Accra\">Africa\/Accra<\/option>\n<option value=\"Africa\/Addis_Ababa\">Africa\/Addis_Ababa<\/option>\n<option value=\"Africa\/Algiers\">Africa\/Algiers<\/option>\n<option value=\"Africa\/Asmara\">Africa\/Asmara<\/option>\n<option value=\"Africa\/Bamako\">Africa\/Bamako<\/option>\n<option value=\"Africa\/Bangui\">Africa\/Bangui<\/option>\n<option value=\"Africa\/Banjul\">Africa\/Banjul<\/option>\n<option value=\"Africa\/Bissau\">Africa\/Bissau<\/option>\n<option value=\"Africa\/Blantyre\">Africa\/Blantyre<\/option>\n<option value=\"Africa\/Brazzaville\">Africa\/Brazzaville<\/option>\n<option value=\"Africa\/Bujumbura\">Africa\/Bujumbura<\/option>\n<option value=\"Africa\/Cairo\">Africa\/Cairo<\/option>\n<option value=\"Africa\/Casablanca\">Africa\/Casablanca<\/option>\n<option value=\"Africa\/Ceuta\">Africa\/Ceuta<\/option>\n<option value=\"Africa\/Conakry\">Africa\/Conakry<\/option>\n<option value=\"Africa\/Dakar\">Africa\/Dakar<\/option>\n<option value=\"Africa\/Dar_es_Salaam\">Africa\/Dar_es_Salaam<\/option>\n<option value=\"Africa\/Djibouti\">Africa\/Djibouti<\/option>\n<option value=\"Africa\/Douala\">Africa\/Douala<\/option>\n<option value=\"Africa\/El_Aaiun\">Africa\/El_Aaiun<\/option>\n<option value=\"Africa\/Freetown\">Africa\/Freetown<\/option>\n<option value=\"Africa\/Gaborone\">Africa\/Gaborone<\/option>\n<option value=\"Africa\/Harare\">Africa\/Harare<\/option>\n<option value=\"Africa\/Johannesburg\">Africa\/Johannesburg<\/option>\n<option value=\"Africa\/Juba\">Africa\/Juba<\/option>\n<option value=\"Africa\/Kampala\">Africa\/Kampala<\/option>\n<option value=\"Africa\/Khartoum\">Africa\/Khartoum<\/option>\n<option value=\"Africa\/Kigali\">Africa\/Kigali<\/option>\n<option value=\"Africa\/Kinshasa\">Africa\/Kinshasa<\/option>\n<option value=\"Africa\/Lagos\">Africa\/Lagos<\/option>\n<option value=\"Africa\/Libreville\">Africa\/Libreville<\/option>\n<option value=\"Africa\/Lome\">Africa\/Lome<\/option>\n<option value=\"Africa\/Luanda\">Africa\/Luanda<\/option>\n<option value=\"Africa\/Lubumbashi\">Africa\/Lubumbashi<\/option>\n<option value=\"Africa\/Lusaka\">Africa\/Lusaka<\/option>\n<option value=\"Africa\/Malabo\">Africa\/Malabo<\/option>\n<option value=\"Africa\/Maputo\">Africa\/Maputo<\/option>\n<option value=\"Africa\/Maseru\">Africa\/Maseru<\/option>\n<option value=\"Africa\/Mbabane\">Africa\/Mbabane<\/option>\n<option value=\"Africa\/Mogadishu\">Africa\/Mogadishu<\/option>\n<option value=\"Africa\/Monrovia\">Africa\/Monrovia<\/option>\n<option value=\"Africa\/Nairobi\">Africa\/Nairobi<\/option>\n<option value=\"Africa\/Ndjamena\">Africa\/Ndjamena<\/option>\n<option value=\"Africa\/Niamey\">Africa\/Niamey<\/option>\n<option value=\"Africa\/Nouakchott\">Africa\/Nouakchott<\/option>\n<option value=\"Africa\/Ouagadougou\">Africa\/Ouagadougou<\/option>\n<option value=\"Africa\/Porto-Novo\">Africa\/Porto-Novo<\/option>\n<option value=\"Africa\/Sao_Tome\">Africa\/Sao_Tome<\/option>\n<option value=\"Africa\/Tripoli\">Africa\/Tripoli<\/option>\n<option value=\"Africa\/Tunis\">Africa\/Tunis<\/option>\n<option value=\"Africa\/Windhoek\">Africa\/Windhoek<\/option>\n<option value=\"America\/Adak\">America\/Adak<\/option>\n<option value=\"America\/Anchorage\">America\/Anchorage<\/option>\n<option value=\"America\/Anguilla\">America\/Anguilla<\/option>\n<option value=\"America\/Antigua\">America\/Antigua<\/option>\n<option value=\"America\/Araguaina\">America\/Araguaina<\/option>\n<option value=\"America\/Argentina\/Buenos_Aires\">America\/Argentina\/Buenos_Aires<\/option>\n<option value=\"America\/Argentina\/Catamarca\">America\/Argentina\/Catamarca<\/option>\n<option value=\"America\/Argentina\/Cordoba\">America\/Argentina\/Cordoba<\/option>\n<option value=\"America\/Argentina\/Jujuy\">America\/Argentina\/Jujuy<\/option>\n<option value=\"America\/Argentina\/La_Rioja\">America\/Argentina\/La_Rioja<\/option>\n<option value=\"America\/Argentina\/Mendoza\">America\/Argentina\/Mendoza<\/option>\n<option value=\"America\/Argentina\/Rio_Gallegos\">America\/Argentina\/Rio_Gallegos<\/option>\n<option value=\"America\/Argentina\/Salta\">America\/Argentina\/Salta<\/option>\n<option value=\"America\/Argentina\/San_Juan\">America\/Argentina\/San_Juan<\/option>\n<option value=\"America\/Argentina\/San_Luis\">America\/Argentina\/San_Luis<\/option>\n<option value=\"America\/Argentina\/Tucuman\">America\/Argentina\/Tucuman<\/option>\n<option value=\"America\/Argentina\/Ushuaia\">America\/Argentina\/Ushuaia<\/option>\n<option value=\"America\/Aruba\">America\/Aruba<\/option>\n<option value=\"America\/Asuncion\">America\/Asuncion<\/option>\n<option value=\"America\/Atikokan\">America\/Atikokan<\/option>\n<option value=\"America\/Bahia\">America\/Bahia<\/option>\n<option value=\"America\/Bahia_Banderas\">America\/Bahia_Banderas<\/option>\n<option value=\"America\/Barbados\">America\/Barbados<\/option>\n<option value=\"America\/Belem\">America\/Belem<\/option>\n<option value=\"America\/Belize\">America\/Belize<\/option>\n<option value=\"America\/Blanc-Sablon\">America\/Blanc-Sablon<\/option>\n<option value=\"America\/Boa_Vista\">America\/Boa_Vista<\/option>\n<option value=\"America\/Bogota\">America\/Bogota<\/option>\n<option value=\"America\/Boise\">America\/Boise<\/option>\n<option value=\"America\/Cambridge_Bay\">America\/Cambridge_Bay<\/option>\n<option value=\"America\/Campo_Grande\">America\/Campo_Grande<\/option>\n<option value=\"America\/Cancun\">America\/Cancun<\/option>\n<option value=\"America\/Caracas\">America\/Caracas<\/option>\n<option value=\"America\/Cayenne\">America\/Cayenne<\/option>\n<option value=\"America\/Cayman\">America\/Cayman<\/option>\n<option value=\"America\/Chicago\">America\/Chicago<\/option>\n<option value=\"America\/Chihuahua\">America\/Chihuahua<\/option>\n<option value=\"America\/Costa_Rica\">America\/Costa_Rica<\/option>\n<option value=\"America\/Creston\">America\/Creston<\/option>\n<option value=\"America\/Cuiaba\">America\/Cuiaba<\/option>\n<option value=\"America\/Curacao\">America\/Curacao<\/option>\n<option value=\"America\/Danmarkshavn\">America\/Danmarkshavn<\/option>\n<option value=\"America\/Dawson\">America\/Dawson<\/option>\n<option value=\"America\/Dawson_Creek\">America\/Dawson_Creek<\/option>\n<option value=\"America\/Denver\">America\/Denver<\/option>\n<option value=\"America\/Detroit\">America\/Detroit<\/option>\n<option value=\"America\/Dominica\">America\/Dominica<\/option>\n<option value=\"America\/Edmonton\">America\/Edmonton<\/option>\n<option value=\"America\/Eirunepe\">America\/Eirunepe<\/option>\n<option value=\"America\/El_Salvador\">America\/El_Salvador<\/option>\n<option value=\"America\/Fort_Nelson\">America\/Fort_Nelson<\/option>\n<option value=\"America\/Fortaleza\">America\/Fortaleza<\/option>\n<option value=\"America\/Glace_Bay\">America\/Glace_Bay<\/option>\n<option value=\"America\/Goose_Bay\">America\/Goose_Bay<\/option>\n<option value=\"America\/Grand_Turk\">America\/Grand_Turk<\/option>\n<option value=\"America\/Grenada\">America\/Grenada<\/option>\n<option value=\"America\/Guadeloupe\">America\/Guadeloupe<\/option>\n<option value=\"America\/Guatemala\">America\/Guatemala<\/option>\n<option value=\"America\/Guayaquil\">America\/Guayaquil<\/option>\n<option value=\"America\/Guyana\">America\/Guyana<\/option>\n<option value=\"America\/Halifax\">America\/Halifax<\/option>\n<option value=\"America\/Havana\">America\/Havana<\/option>\n<option value=\"America\/Hermosillo\">America\/Hermosillo<\/option>\n<option value=\"America\/Indiana\/Indianapolis\">America\/Indiana\/Indianapolis<\/option>\n<option value=\"America\/Indiana\/Knox\">America\/Indiana\/Knox<\/option>\n<option value=\"America\/Indiana\/Marengo\">America\/Indiana\/Marengo<\/option>\n<option value=\"America\/Indiana\/Petersburg\">America\/Indiana\/Petersburg<\/option>\n<option value=\"America\/Indiana\/Tell_City\">America\/Indiana\/Tell_City<\/option>\n<option value=\"America\/Indiana\/Vevay\">America\/Indiana\/Vevay<\/option>\n<option value=\"America\/Indiana\/Vincennes\">America\/Indiana\/Vincennes<\/option>\n<option value=\"America\/Indiana\/Winamac\">America\/Indiana\/Winamac<\/option>\n<option value=\"America\/Inuvik\">America\/Inuvik<\/option>\n<option value=\"America\/Iqaluit\">America\/Iqaluit<\/option>\n<option value=\"America\/Jamaica\">America\/Jamaica<\/option>\n<option value=\"America\/Juneau\">America\/Juneau<\/option>\n<option value=\"America\/Kentucky\/Louisville\">America\/Kentucky\/Louisville<\/option>\n<option value=\"America\/Kentucky\/Monticello\">America\/Kentucky\/Monticello<\/option>\n<option value=\"America\/Kralendijk\">America\/Kralendijk<\/option>\n<option value=\"America\/La_Paz\">America\/La_Paz<\/option>\n<option value=\"America\/Lima\">America\/Lima<\/option>\n<option value=\"America\/Los_Angeles\">America\/Los_Angeles<\/option>\n<option value=\"America\/Lower_Princes\">America\/Lower_Princes<\/option>\n<option value=\"America\/Maceio\">America\/Maceio<\/option>\n<option value=\"America\/Managua\">America\/Managua<\/option>\n<option value=\"America\/Manaus\">America\/Manaus<\/option>\n<option value=\"America\/Marigot\">America\/Marigot<\/option>\n<option value=\"America\/Martinique\">America\/Martinique<\/option>\n<option value=\"America\/Matamoros\">America\/Matamoros<\/option>\n<option value=\"America\/Mazatlan\">America\/Mazatlan<\/option>\n<option value=\"America\/Menominee\">America\/Menominee<\/option>\n<option value=\"America\/Merida\">America\/Merida<\/option>\n<option value=\"America\/Metlakatla\">America\/Metlakatla<\/option>\n<option value=\"America\/Mexico_City\">America\/Mexico_City<\/option>\n<option value=\"America\/Miquelon\">America\/Miquelon<\/option>\n<option value=\"America\/Moncton\">America\/Moncton<\/option>\n<option value=\"America\/Monterrey\">America\/Monterrey<\/option>\n<option value=\"America\/Montevideo\">America\/Montevideo<\/option>\n<option value=\"America\/Montserrat\">America\/Montserrat<\/option>\n<option value=\"America\/Nassau\">America\/Nassau<\/option>\n<option value=\"America\/New_York\">America\/New_York<\/option>\n<option value=\"America\/Nipigon\">America\/Nipigon<\/option>\n<option value=\"America\/Nome\">America\/Nome<\/option>\n<option value=\"America\/Noronha\">America\/Noronha<\/option>\n<option value=\"America\/North_Dakota\/Beulah\">America\/North_Dakota\/Beulah<\/option>\n<option value=\"America\/North_Dakota\/Center\">America\/North_Dakota\/Center<\/option>\n<option value=\"America\/North_Dakota\/New_Salem\">America\/North_Dakota\/New_Salem<\/option>\n<option value=\"America\/Nuuk\">America\/Nuuk<\/option>\n<option value=\"America\/Ojinaga\">America\/Ojinaga<\/option>\n<option value=\"America\/Panama\">America\/Panama<\/option>\n<option value=\"America\/Pangnirtung\">America\/Pangnirtung<\/option>\n<option value=\"America\/Paramaribo\">America\/Paramaribo<\/option>\n<option value=\"America\/Phoenix\">America\/Phoenix<\/option>\n<option value=\"America\/Port-au-Prince\">America\/Port-au-Prince<\/option>\n<option value=\"America\/Port_of_Spain\">America\/Port_of_Spain<\/option>\n<option value=\"America\/Porto_Velho\">America\/Porto_Velho<\/option>\n<option value=\"America\/Puerto_Rico\">America\/Puerto_Rico<\/option>\n<option value=\"America\/Punta_Arenas\">America\/Punta_Arenas<\/option>\n<option value=\"America\/Rainy_River\">America\/Rainy_River<\/option>\n<option value=\"America\/Rankin_Inlet\">America\/Rankin_Inlet<\/option>\n<option value=\"America\/Recife\">America\/Recife<\/option>\n<option value=\"America\/Regina\">America\/Regina<\/option>\n<option value=\"America\/Resolute\">America\/Resolute<\/option>\n<option value=\"America\/Rio_Branco\">America\/Rio_Branco<\/option>\n<option value=\"America\/Santarem\">America\/Santarem<\/option>\n<option value=\"America\/Santiago\">America\/Santiago<\/option>\n<option value=\"America\/Santo_Domingo\">America\/Santo_Domingo<\/option>\n<option value=\"America\/Sao_Paulo\">America\/Sao_Paulo<\/option>\n<option value=\"America\/Scoresbysund\">America\/Scoresbysund<\/option>\n<option value=\"America\/Sitka\">America\/Sitka<\/option>\n<option value=\"America\/St_Barthelemy\">America\/St_Barthelemy<\/option>\n<option value=\"America\/St_Johns\">America\/St_Johns<\/option>\n<option value=\"America\/St_Kitts\">America\/St_Kitts<\/option>\n<option value=\"America\/St_Lucia\">America\/St_Lucia<\/option>\n<option value=\"America\/St_Thomas\">America\/St_Thomas<\/option>\n<option value=\"America\/St_Vincent\">America\/St_Vincent<\/option>\n<option value=\"America\/Swift_Current\">America\/Swift_Current<\/option>\n<option value=\"America\/Tegucigalpa\">America\/Tegucigalpa<\/option>\n<option value=\"America\/Thule\">America\/Thule<\/option>\n<option value=\"America\/Thunder_Bay\">America\/Thunder_Bay<\/option>\n<option value=\"America\/Tijuana\">America\/Tijuana<\/option>\n<option value=\"America\/Toronto\">America\/Toronto<\/option>\n<option value=\"America\/Tortola\">America\/Tortola<\/option>\n<option value=\"America\/Vancouver\">America\/Vancouver<\/option>\n<option value=\"America\/Whitehorse\">America\/Whitehorse<\/option>\n<option value=\"America\/Winnipeg\">America\/Winnipeg<\/option>\n<option value=\"America\/Yakutat\">America\/Yakutat<\/option>\n<option value=\"America\/Yellowknife\">America\/Yellowknife<\/option>\n<option value=\"Antarctica\/Casey\">Antarctica\/Casey<\/option>\n<option value=\"Antarctica\/Davis\">Antarctica\/Davis<\/option>\n<option value=\"Antarctica\/DumontDUrville\">Antarctica\/DumontDUrville<\/option>\n<option value=\"Antarctica\/Macquarie\">Antarctica\/Macquarie<\/option>\n<option value=\"Antarctica\/Mawson\">Antarctica\/Mawson<\/option>\n<option value=\"Antarctica\/McMurdo\">Antarctica\/McMurdo<\/option>\n<option value=\"Antarctica\/Palmer\">Antarctica\/Palmer<\/option>\n<option value=\"Antarctica\/Rothera\">Antarctica\/Rothera<\/option>\n<option value=\"Antarctica\/Syowa\">Antarctica\/Syowa<\/option>\n<option value=\"Antarctica\/Troll\">Antarctica\/Troll<\/option>\n<option value=\"Antarctica\/Vostok\">Antarctica\/Vostok<\/option>\n<option value=\"Arctic\/Longyearbyen\">Arctic\/Longyearbyen<\/option>\n<option value=\"Asia\/Aden\">Asia\/Aden<\/option>\n<option value=\"Asia\/Almaty\">Asia\/Almaty<\/option>\n<option value=\"Asia\/Amman\">Asia\/Amman<\/option>\n<option value=\"Asia\/Anadyr\">Asia\/Anadyr<\/option>\n<option value=\"Asia\/Aqtau\">Asia\/Aqtau<\/option>\n<option value=\"Asia\/Aqtobe\">Asia\/Aqtobe<\/option>\n<option value=\"Asia\/Ashgabat\">Asia\/Ashgabat<\/option>\n<option value=\"Asia\/Atyrau\">Asia\/Atyrau<\/option>\n<option value=\"Asia\/Baghdad\">Asia\/Baghdad<\/option>\n<option value=\"Asia\/Bahrain\">Asia\/Bahrain<\/option>\n<option value=\"Asia\/Baku\">Asia\/Baku<\/option>\n<option value=\"Asia\/Bangkok\">Asia\/Bangkok<\/option>\n<option value=\"Asia\/Barnaul\">Asia\/Barnaul<\/option>\n<option value=\"Asia\/Beirut\">Asia\/Beirut<\/option>\n<option value=\"Asia\/Bishkek\">Asia\/Bishkek<\/option>\n<option value=\"Asia\/Brunei\">Asia\/Brunei<\/option>\n<option value=\"Asia\/Chita\">Asia\/Chita<\/option>\n<option value=\"Asia\/Choibalsan\">Asia\/Choibalsan<\/option>\n<option value=\"Asia\/Colombo\">Asia\/Colombo<\/option>\n<option value=\"Asia\/Damascus\">Asia\/Damascus<\/option>\n<option value=\"Asia\/Dhaka\">Asia\/Dhaka<\/option>\n<option value=\"Asia\/Dili\">Asia\/Dili<\/option>\n<option value=\"Asia\/Dubai\">Asia\/Dubai<\/option>\n<option value=\"Asia\/Dushanbe\">Asia\/Dushanbe<\/option>\n<option value=\"Asia\/Famagusta\">Asia\/Famagusta<\/option>\n<option value=\"Asia\/Gaza\">Asia\/Gaza<\/option>\n<option value=\"Asia\/Hebron\">Asia\/Hebron<\/option>\n<option value=\"Asia\/Ho_Chi_Minh\">Asia\/Ho_Chi_Minh<\/option>\n<option value=\"Asia\/Hong_Kong\">Asia\/Hong_Kong<\/option>\n<option value=\"Asia\/Hovd\">Asia\/Hovd<\/option>\n<option value=\"Asia\/Irkutsk\">Asia\/Irkutsk<\/option>\n<option value=\"Asia\/Jakarta\">Asia\/Jakarta<\/option>\n<option value=\"Asia\/Jayapura\">Asia\/Jayapura<\/option>\n<option value=\"Asia\/Jerusalem\">Asia\/Jerusalem<\/option>\n<option value=\"Asia\/Kabul\">Asia\/Kabul<\/option>\n<option value=\"Asia\/Kamchatka\">Asia\/Kamchatka<\/option>\n<option value=\"Asia\/Karachi\">Asia\/Karachi<\/option>\n<option value=\"Asia\/Kathmandu\">Asia\/Kathmandu<\/option>\n<option value=\"Asia\/Khandyga\">Asia\/Khandyga<\/option>\n<option value=\"Asia\/Kolkata\">Asia\/Kolkata<\/option>\n<option value=\"Asia\/Krasnoyarsk\">Asia\/Krasnoyarsk<\/option>\n<option value=\"Asia\/Kuala_Lumpur\">Asia\/Kuala_Lumpur<\/option>\n<option value=\"Asia\/Kuching\">Asia\/Kuching<\/option>\n<option value=\"Asia\/Kuwait\">Asia\/Kuwait<\/option>\n<option value=\"Asia\/Macau\">Asia\/Macau<\/option>\n<option value=\"Asia\/Magadan\">Asia\/Magadan<\/option>\n<option value=\"Asia\/Makassar\">Asia\/Makassar<\/option>\n<option value=\"Asia\/Manila\">Asia\/Manila<\/option>\n<option value=\"Asia\/Muscat\">Asia\/Muscat<\/option>\n<option value=\"Asia\/Nicosia\">Asia\/Nicosia<\/option>\n<option value=\"Asia\/Novokuznetsk\">Asia\/Novokuznetsk<\/option>\n<option value=\"Asia\/Novosibirsk\">Asia\/Novosibirsk<\/option>\n<option value=\"Asia\/Omsk\">Asia\/Omsk<\/option>\n<option value=\"Asia\/Oral\">Asia\/Oral<\/option>\n<option value=\"Asia\/Phnom_Penh\">Asia\/Phnom_Penh<\/option>\n<option value=\"Asia\/Pontianak\">Asia\/Pontianak<\/option>\n<option value=\"Asia\/Pyongyang\">Asia\/Pyongyang<\/option>\n<option value=\"Asia\/Qatar\">Asia\/Qatar<\/option>\n<option value=\"Asia\/Qostanay\">Asia\/Qostanay<\/option>\n<option value=\"Asia\/Qyzylorda\">Asia\/Qyzylorda<\/option>\n<option value=\"Asia\/Riyadh\">Asia\/Riyadh<\/option>\n<option value=\"Asia\/Sakhalin\">Asia\/Sakhalin<\/option>\n<option value=\"Asia\/Samarkand\">Asia\/Samarkand<\/option>\n<option value=\"Asia\/Seoul\">Asia\/Seoul<\/option>\n<option value=\"Asia\/Shanghai\">Asia\/Shanghai<\/option>\n<option value=\"Asia\/Singapore\">Asia\/Singapore<\/option>\n<option value=\"Asia\/Srednekolymsk\">Asia\/Srednekolymsk<\/option>\n<option value=\"Asia\/Taipei\">Asia\/Taipei<\/option>\n<option value=\"Asia\/Tashkent\">Asia\/Tashkent<\/option>\n<option value=\"Asia\/Tbilisi\">Asia\/Tbilisi<\/option>\n<option value=\"Asia\/Tehran\">Asia\/Tehran<\/option>\n<option value=\"Asia\/Thimphu\">Asia\/Thimphu<\/option>\n<option value=\"Asia\/Tokyo\">Asia\/Tokyo<\/option>\n<option value=\"Asia\/Tomsk\">Asia\/Tomsk<\/option>\n<option value=\"Asia\/Ulaanbaatar\">Asia\/Ulaanbaatar<\/option>\n<option value=\"Asia\/Urumqi\">Asia\/Urumqi<\/option>\n<option value=\"Asia\/Ust-Nera\">Asia\/Ust-Nera<\/option>\n<option value=\"Asia\/Vientiane\">Asia\/Vientiane<\/option>\n<option value=\"Asia\/Vladivostok\">Asia\/Vladivostok<\/option>\n<option value=\"Asia\/Yakutsk\">Asia\/Yakutsk<\/option>\n<option value=\"Asia\/Yangon\">Asia\/Yangon<\/option>\n<option value=\"Asia\/Yekaterinburg\">Asia\/Yekaterinburg<\/option>\n<option value=\"Asia\/Yerevan\">Asia\/Yerevan<\/option>\n<option value=\"Atlantic\/Azores\">Atlantic\/Azores<\/option>\n<option value=\"Atlantic\/Bermuda\">Atlantic\/Bermuda<\/option>\n<option value=\"Atlantic\/Canary\">Atlantic\/Canary<\/option>\n<option value=\"Atlantic\/Cape_Verde\">Atlantic\/Cape_Verde<\/option>\n<option value=\"Atlantic\/Faroe\">Atlantic\/Faroe<\/option>\n<option value=\"Atlantic\/Madeira\">Atlantic\/Madeira<\/option>\n<option value=\"Atlantic\/Reykjavik\">Atlantic\/Reykjavik<\/option>\n<option value=\"Atlantic\/South_Georgia\">Atlantic\/South_Georgia<\/option>\n<option value=\"Atlantic\/St_Helena\">Atlantic\/St_Helena<\/option>\n<option value=\"Atlantic\/Stanley\">Atlantic\/Stanley<\/option>\n<option value=\"Australia\/Adelaide\">Australia\/Adelaide<\/option>\n<option value=\"Australia\/Brisbane\">Australia\/Brisbane<\/option>\n<option value=\"Australia\/Broken_Hill\">Australia\/Broken_Hill<\/option>\n<option value=\"Australia\/Darwin\">Australia\/Darwin<\/option>\n<option value=\"Australia\/Eucla\">Australia\/Eucla<\/option>\n<option value=\"Australia\/Hobart\">Australia\/Hobart<\/option>\n<option value=\"Australia\/Lindeman\">Australia\/Lindeman<\/option>\n<option value=\"Australia\/Lord_Howe\">Australia\/Lord_Howe<\/option>\n<option value=\"Australia\/Melbourne\">Australia\/Melbourne<\/option>\n<option value=\"Australia\/Perth\">Australia\/Perth<\/option>\n<option value=\"Australia\/Sydney\">Australia\/Sydney<\/option>\n<option value=\"Europe\/Amsterdam\">Europe\/Amsterdam<\/option>\n<option value=\"Europe\/Andorra\">Europe\/Andorra<\/option>\n<option value=\"Europe\/Astrakhan\">Europe\/Astrakhan<\/option>\n<option value=\"Europe\/Athens\">Europe\/Athens<\/option>\n<option value=\"Europe\/Belgrade\">Europe\/Belgrade<\/option>\n<option value=\"Europe\/Berlin\">Europe\/Berlin<\/option>\n<option value=\"Europe\/Bratislava\">Europe\/Bratislava<\/option>\n<option value=\"Europe\/Brussels\">Europe\/Brussels<\/option>\n<option value=\"Europe\/Bucharest\">Europe\/Bucharest<\/option>\n<option value=\"Europe\/Budapest\">Europe\/Budapest<\/option>\n<option value=\"Europe\/Busingen\">Europe\/Busingen<\/option>\n<option value=\"Europe\/Chisinau\">Europe\/Chisinau<\/option>\n<option value=\"Europe\/Copenhagen\">Europe\/Copenhagen<\/option>\n<option value=\"Europe\/Dublin\">Europe\/Dublin<\/option>\n<option value=\"Europe\/Gibraltar\">Europe\/Gibraltar<\/option>\n<option value=\"Europe\/Guernsey\">Europe\/Guernsey<\/option>\n<option value=\"Europe\/Helsinki\">Europe\/Helsinki<\/option>\n<option value=\"Europe\/Isle_of_Man\">Europe\/Isle_of_Man<\/option>\n<option value=\"Europe\/Istanbul\">Europe\/Istanbul<\/option>\n<option value=\"Europe\/Jersey\">Europe\/Jersey<\/option>\n<option value=\"Europe\/Kaliningrad\">Europe\/Kaliningrad<\/option>\n<option value=\"Europe\/Kiev\">Europe\/Kiev<\/option>\n<option value=\"Europe\/Kirov\">Europe\/Kirov<\/option>\n<option value=\"Europe\/Lisbon\">Europe\/Lisbon<\/option>\n<option value=\"Europe\/Ljubljana\">Europe\/Ljubljana<\/option>\n<option value=\"Europe\/London\" selected=\"selected\">Europe\/London<\/option>\n<option value=\"Europe\/Luxembourg\">Europe\/Luxembourg<\/option>\n<option value=\"Europe\/Madrid\">Europe\/Madrid<\/option>\n<option value=\"Europe\/Malta\">Europe\/Malta<\/option>\n<option value=\"Europe\/Mariehamn\">Europe\/Mariehamn<\/option>\n<option value=\"Europe\/Minsk\">Europe\/Minsk<\/option>\n<option value=\"Europe\/Monaco\">Europe\/Monaco<\/option>\n<option value=\"Europe\/Moscow\">Europe\/Moscow<\/option>\n<option value=\"Europe\/Oslo\">Europe\/Oslo<\/option>\n<option value=\"Europe\/Paris\">Europe\/Paris<\/option>\n<option value=\"Europe\/Podgorica\">Europe\/Podgorica<\/option>\n<option value=\"Europe\/Prague\">Europe\/Prague<\/option>\n<option value=\"Europe\/Riga\">Europe\/Riga<\/option>\n<option value=\"Europe\/Rome\">Europe\/Rome<\/option>\n<option value=\"Europe\/Samara\">Europe\/Samara<\/option>\n<option value=\"Europe\/San_Marino\">Europe\/San_Marino<\/option>\n<option value=\"Europe\/Sarajevo\">Europe\/Sarajevo<\/option>\n<option value=\"Europe\/Saratov\">Europe\/Saratov<\/option>\n<option value=\"Europe\/Simferopol\">Europe\/Simferopol<\/option>\n<option value=\"Europe\/Skopje\">Europe\/Skopje<\/option>\n<option value=\"Europe\/Sofia\">Europe\/Sofia<\/option>\n<option value=\"Europe\/Stockholm\">Europe\/Stockholm<\/option>\n<option value=\"Europe\/Tallinn\">Europe\/Tallinn<\/option>\n<option value=\"Europe\/Tirane\">Europe\/Tirane<\/option>\n<option value=\"Europe\/Ulyanovsk\">Europe\/Ulyanovsk<\/option>\n<option value=\"Europe\/Uzhgorod\">Europe\/Uzhgorod<\/option>\n<option value=\"Europe\/Vaduz\">Europe\/Vaduz<\/option>\n<option value=\"Europe\/Vatican\">Europe\/Vatican<\/option>\n<option value=\"Europe\/Vienna\">Europe\/Vienna<\/option>\n<option value=\"Europe\/Vilnius\">Europe\/Vilnius<\/option>\n<option value=\"Europe\/Volgograd\">Europe\/Volgograd<\/option>\n<option value=\"Europe\/Warsaw\">Europe\/Warsaw<\/option>\n<option value=\"Europe\/Zagreb\">Europe\/Zagreb<\/option>\n<option value=\"Europe\/Zaporozhye\">Europe\/Zaporozhye<\/option>\n<option value=\"Europe\/Zurich\">Europe\/Zurich<\/option>\n<option value=\"Indian\/Antananarivo\">Indian\/Antananarivo<\/option>\n<option value=\"Indian\/Chagos\">Indian\/Chagos<\/option>\n<option value=\"Indian\/Christmas\">Indian\/Christmas<\/option>\n<option value=\"Indian\/Cocos\">Indian\/Cocos<\/option>\n<option value=\"Indian\/Comoro\">Indian\/Comoro<\/option>\n<option value=\"Indian\/Kerguelen\">Indian\/Kerguelen<\/option>\n<option value=\"Indian\/Mahe\">Indian\/Mahe<\/option>\n<option value=\"Indian\/Maldives\">Indian\/Maldives<\/option>\n<option value=\"Indian\/Mauritius\">Indian\/Mauritius<\/option>\n<option value=\"Indian\/Mayotte\">Indian\/Mayotte<\/option>\n<option value=\"Indian\/Reunion\">Indian\/Reunion<\/option>\n<option value=\"Pacific\/Apia\">Pacific\/Apia<\/option>\n<option value=\"Pacific\/Auckland\">Pacific\/Auckland<\/option>\n<option value=\"Pacific\/Bougainville\">Pacific\/Bougainville<\/option>\n<option value=\"Pacific\/Chatham\">Pacific\/Chatham<\/option>\n<option value=\"Pacific\/Chuuk\">Pacific\/Chuuk<\/option>\n<option value=\"Pacific\/Easter\">Pacific\/Easter<\/option>\n<option value=\"Pacific\/Efate\">Pacific\/Efate<\/option>\n<option value=\"Pacific\/Fakaofo\">Pacific\/Fakaofo<\/option>\n<option value=\"Pacific\/Fiji\">Pacific\/Fiji<\/option>\n<option value=\"Pacific\/Funafuti\">Pacific\/Funafuti<\/option>\n<option value=\"Pacific\/Galapagos\">Pacific\/Galapagos<\/option>\n<option value=\"Pacific\/Gambier\">Pacific\/Gambier<\/option>\n<option value=\"Pacific\/Guadalcanal\">Pacific\/Guadalcanal<\/option>\n<option value=\"Pacific\/Guam\">Pacific\/Guam<\/option>\n<option value=\"Pacific\/Honolulu\">Pacific\/Honolulu<\/option>\n<option value=\"Pacific\/Kanton\">Pacific\/Kanton<\/option>\n<option value=\"Pacific\/Kiritimati\">Pacific\/Kiritimati<\/option>\n<option value=\"Pacific\/Kosrae\">Pacific\/Kosrae<\/option>\n<option value=\"Pacific\/Kwajalein\">Pacific\/Kwajalein<\/option>\n<option value=\"Pacific\/Majuro\">Pacific\/Majuro<\/option>\n<option value=\"Pacific\/Marquesas\">Pacific\/Marquesas<\/option>\n<option 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value=\"Pacific\/Wake\">Pacific\/Wake<\/option>\n<option value=\"Pacific\/Wallis\">Pacific\/Wallis<\/option>\n<option value=\"UTC\">UTC<\/option><\/select>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-bs-form-group drts-location-address-latlng drts-form-field drts-form-type-map-latlng\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][_latlng]\">\n<div class=\"drts-bs-form-row\"><div class=\"drts-bs-col-sm-6\">\n<div class=\"drts-bs-form-group drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_location_new][0][location][address][_latlng][lat]\">\n    <label>Latitude<\/label>\n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_location_new][0][location][address][_latlng][lat]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-map-field-lat\" maxlength=\"255\" \/>\n        <div 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